What’s new in updated brachytherapy guideline

A guideline update on brachytherapy for prostate cancer provides evidence-based recommendations for different patient risk groups and specifies the most effective forms of the treatment, either by itself or as part of a combination approach.

The update, published online in the Journal of Clinical Oncology (March 27, 2017), was created by an expert panel from the American Society of Clinical Oncology and Cancer Care Ontario that viewed relevant literature published between 2011 and December 2016 and found evidence from five randomized controlled clinical trials. The past guidelines had been in place for about 10 years.

“We had a multidisciplinary panel of experts and, in terms of a research perspective and in terms of a patient-decision perspective, the gold standard right now is brachytherapy,” Andrew Loblaw, MD, MSc, of Odette Cancer Institute, Sunnybrook Health Sciences Centre, Toronto, and a co-chair of the expert panel that developed the guideline update, told Urology Times. “Brachytherapy is actually more convenient than external beam radiotherapy, and I think that’s also important to patients.”

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The recommendations are aimed at men newly diagnosed with prostate cancer who require or choose active treatment and are either not suitable or not considering active surveillance.

“I’ve seen patients struggle with all the different options there are, and I think one of the most important pieces of information that comes from this guideline is it helps narrow the focus of a decision,” Dr. Loblaw said. “If they are thinking about radiation treatment, for example, we first think, ‘can this patient have brachytherapy treatment?’ whereas before we had to go through a conversation about all the other various types of radiation treatment.”

Next: What the guideline recommends

The updated guideline says that for eligible patients with low-risk prostate cancer, either low-dose-rate (LDR) brachytherapy alone, external beam radiotherapy alone, or radical prostatectomy should be offered but for eligible men with low-intermediate risk prostate cancer (Gleason 7, PSA <10 ng/mL or Gleason 6, PSA 10-20 ng/mL), LDR brachytherapy alone may be offered.

For eligible patients with intermediate-risk prostate cancer who choose to receive EBRT with or without androgen deprivation therapy, addition of LDR or high-dose-rate (HDR) brachytherapy boost should be offered.

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Additionally, for those with high-risk prostate cancer receiving EBRT and ADT, brachytherapy boost (LDR or HDR) should be offered.

According to Dr. Loblaw, brachytherapy is not only more convenient than EBRT but it offers a much greater chance of curing the disease. Still, not every patient should have brachytherapy and not all treatment centers are experienced in delivering high-quality brachytherapy. Patients may be ineligible if they have moderate to severe urinary symptoms, an enlarged prostate, prior prostate surgery, or poor physical health.

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